To Recognize the Zebra - How to characterize future health threats

by Christopher Eddy, M.P.H., REHS, CP-FS

What the world does not need is another lecture on risk. In fact, I have little interest in risk: in our forthcoming publication (Eddy, Sase 2023),* we focus on the consequences of foreseeable health threats, rather future disasters/crises that will be man-made, natural, and intentional in origin. We emphasize that risk is a probabilistic notion that almost always is impossible to predict with much success at achieving the target of global public health done well, prevention. Issue Number 1 will present prevention discussion.

*A Retrospective of the 2011 Fukushima Nuclear Disaster: An All-Hazards Emergency Management and Public Health Crisis Cycle Using Lessons Learned From the COVID-19 Pandemic (forthcoming March 2023, on the 12th anniversary of the disaster)

“If you hear hoof beats, don’t expect Zebras,” is an oft-repeated phrase in medicine that warns new students not to let their imagination lead them errantly. It may have been true in 1970, though exactly descriptive, in reverse, of what we learned in the existential COVID-19 Pandemic — we must be more imaginative about emerging health threats, allowing planning space for Nicholas Taleb’s “Black Swan,” an unanticipated ultra-rare event that was in essence previously considered impossible. The best Emergency Mangers know this, but in my experience, many more unfortunately… do not.

I have said before that if you show me a pressing public health issue, I will show you controversy bordering on conspiracy theory. The 2011 Fukushima Nuclear Disaster triple nuclear reactor meltdown (most people in the world don’t know still), is planned for clean-up by 2061, while the remaining nuclear fuel lays vulnerable to cataclysmic reignition by typhoons, war, and the original trigger event — a tsunami caused by an earthquake. The 2014 Ebola Crisis, Dallas Texas: the first time I heard an [completely expected] outbreak described as a “Zebra Event” by hospital physicians preparing the root cause analysis of the infection prevention and control failure. CDC sent official health alerts with guidance to all hospitals and I was there. And…